In this blog, ARC researchers Dr. Sowmiya Moorthie and Dr. Carol Brayne discuss ways to achieve longer term sustainable relationships with the communities they work with, through reporting on a series of interviews they conducted with experts who have been involved in developing and delivering strategies for community involvement.
How can researchers connect with whole communities?Learnings through an expert witness process
Working in partnership with communities and citizens is seen as key in a population health approach and an important component to enhancing the value and achieving impact from health and care services research, implementation and delivery processes. There is a large body of research and literature exploring how to achieve better community engagement including embedded research and learning with people in the places they live and work. Such approaches are usually highly focused around a specific area such as a risk – physical activity, a disease – dementia or a stage of life – palliative care. This type of engagement is strongly evidenced across the work of the National Institute of Health and Care Research Applied Research Collaboration in the East of England (ARC EoE), where there is great depth of knowledge on Patient and Public Involvement in research, and relationships with several localities in the EoE, particularly its four Populations in Focus, is strong.
Our theme has undertaken work aiming to improve our understanding on how to build on these current efforts and achieve longer term sustainable relationships with the communities with which we work. Specifically, we wanted to gather knowledge of methods and mechanisms for what we termed ‘deep community engagement, co-working and co-production (DCCC)’. We defined this as engaging whole populations in an inclusive approach supporting the building of longer term sustained relationships. Such a holistic approach would complement and build upon the current engagement activities in relation to specific projects, and provide an avenue for developing an embedded and sustained model of evidence generation with people in their communities and place.
To do this, we conducted a series of interviews with experts who had been involved in developing and delivering strategies for community involvement, especially at a whole population level over prolonged periods in different ways. This ranged from a deeply embedded longstanding community and primary care hubs (Bromley-by-Bow Centre, Wells Community hospital), to research leaders with years of experience in setting up whole system engagement in the North West of England.
Below we have highlighted some of the key learning from their extensive and diverse experiences.
The concept of community is complex and nebulous
Communities can be described through different lenses, they are not homogeneous entities and can be composed of transient populations. Communities might coalesce around a particular geography (communities of place) or through other shared cultural, social, economic and/or political aspects (communities of interest) that may span different geographies. A nuanced understanding of the population, as well as the different strands of the population, is key in DCCC. Developing an understanding of the population in itself will involve building relationships through different platforms and forms of engagement. Initial engagement may be focused on relationship building, rather than on a specific objective or outcome.
Different methods can be used for engagement
There is a diversity of views on community, engagement, involvement, co-working and co-production. This together with the fact that communities can be described through different lenses and not homogenous entities, means involvement can take a variety of forms. Achieving DCCC will require a multi-layered or and multi-dimensional approach, depending on the exquisite knowledge and detail of how communities are defined and the purpose of the exercise of involvement.
Particular approaches and methods may be suitable depending on the type of involvement or engagement that is sought. For example, community involvement may be from an advisory perspective, as part of research (lay researchers), analysis or at the point of delivery of research findings. Involvement across the research process from creation of appropriate questions, particular research development and inception to delivery. These stages are likely to require types of engagement at different levels and with different groups and communities. Different processes and approaches may be suitable across this spectrum of activities.
A consistent and important message from the interviews was that, in some instances, particular methods or approaches may not work. Expert witnesses expressed that there needs to be a willingness to try a range of approaches, acknowledging the fact that there is likely to be fluidity in membership of different groups which may influence the approach taken, whilst emphasising the need for the longer term sustainable relationships that might underpin this flexibility.
Below is a list of key principles for achieving deep community engagement, co-working and co-production.
- Acknowledging power dynamics between those involved in the process, building trust, and awareness that engagement is often an evolving process.
- Communities are diverse, and take different shapes, and their involvement and role in shaping and delivering research can be varied at any one time and across time. This means that having clarity about the purpose of the engagement, and expected outcomes for those involved is vital. The two-way nature and mutual benefits must be considered from the outset.
- The importance of capturing the outcomes and effectiveness of engagement processes was also emphasised by interviewees. This could include broad outcomes such as the willingness for people to stay involved and participate in different initiatives. Specific outcomes would be related to the purpose of the engagement and co-production where appropriate is important.
The ideal model is an enduring long term infrastructure with embedded research practitioners knowledgeable about and part of the communities of interest, themselves supported by not only the research infrastructures but also the locality infrastructures. This type of infrastructure then in its own right can develop the more nuanced approaches required above for specific groups within population and locality where the needs are likely to be more flexible and have variable timeframes. A governance structure from the community and from the research supportive community is also essential to this type of development. Without such an investment into place based co-produced and welcomed research infrastructure, future research will be inhibited from achieving true benefit for people in place in a sustainable manner. We hope to move towards developing and achieving such a model.
We are grateful for the insights provided by the individuals interviewed during the course of our DCCC project, particularly given their timing within the COVID pandemic.
- Research project
- Research theme